Health Care Across the Globe: A Conversation with Nancy Aossey

July 1, 2009

Nancy A. Aossey is President & CEO of International Medical Corps (IMC), an international non-governmental organization dedicated to saving lives and relieving suffering through medical relief, health care training, and development programs that build self-reliance. Under Nancy’s nearly two-and-a-half-decade stewardship, International Medical Corps has delivered life-saving assistance to tens of millions of the world’s most vulnerable people. We sat down with her to talk about how she does it.

ZocDoc: Tell us about the International Medical Corps and the work you do.

Aossey: We’re considered a relief and development organization, primarily focused on the global health agenda, which also includes our own collective welfare. The Universal Declaration of Human Rights basically promises all people a standard of living which includes health and well being. And special care is promised to mothers and children. Obviously this fundamental right is not suspended because there’s a conflict or a disaster or an emergency in any given place, so the right to the highest standard of health still remains a global promise and motivates our work at International Medical Corps. Our core activity is helping to eliminate inequities in health worldwide.

ZocDoc: How do you go about doing that?

Aossey: If you strengthen local health care systems, then you make it more possible for local communities to access the care that they need and deserve. This is what we’ve been doing all along, starting in Afghanistan 25 years ago, and it is what we continue to do in 27 different countries and regions today. Throughout the developing world, many health systems have been devastated by conflict and poverty that we have to address if we’re going to achieve an adequate level of global health. The need for trained health professionals is urgent here in the US and in Europe, but it’s absolutely vital in Africa and Asia, where there are tremendous gaps. So we’re trying to help bridge some of those gaps with comprehensive training for health workers. The needs of every country are different. If you just focus on infant mortality, for instance, but you don’t address maternal mortality, one will certainly impact upon the other. Our focus is on health care training and training people locally so that they can deliver the health care services themselves. At the end of the day, there need to be health professionals to deliver services in all these various areas.

ZocDoc: So are people receiving the same training, or are they learning specific skills?

Aossey: They could absolutely be learning one specific skill, but it needs to be complemented by other people with a separate set of skills. So for instance, in a country where the infant mortality rate is high, we train people to vaccinate children. However, we’ll also need traditional birth attendants to deliver healthy babies, so we may also train them. There may be doctors in a particular country, but often they don’t exist. In conflict areas, they’ve been forced to flee, or they’ve been killed, or they are just unable to operate. We will work with the doctor to determine what the skill level is, and we will try to bring up their skill level to help them deal with the current reality of what is needed. We also provide refresher training to doctors and nurses. We can’t do it all, of course, but we prioritize. We invest in human capital in those countries.

ZocDoc: How much cooperation do you receive from foreign governments?

Aossey: We were founded in 1984 in response to the Soviet invasion of Afghanistan. The Soviet Union imprisoned, exiled, or killed almost all of the doctors and health professionals in that country as a way to deny the Afghan civilians health care services. In that case, we didn’t have any government cooperation whatsoever and we went into little villages and worked directly with the people. Now it’s different. The government in Afghanistan cares about its people and their health, and we work closely with the Ministry of Health to support their work. If the government cares about its people, and they’re just unable to help them, we help the government by working directly with their communities. When the government doesn’t want us there, then we have no support whatsoever, and it can be a very tenuous and risky situation. This is often the situation we’re in.

ZocDoc: In 25 years, how have technological advances influenced your work?

Aossey: Well, as new technologies for immunization are developed, we’ve actually incorporated them into our core programming. Just one shot of pentavalent vaccine immunizes against Diphtheria, Tetanus, Hepatitis B, and Pertussis and Hib – these things that cause meningitis and pneumonia. Obviously this has a huge impact on the logistics of immunization programs for the many children that we’re serving in displaced populations. We’ve also used geospatial mapping to assist in our health reporting and our disease surveillance activities. It basically gives us an ever-moving and ever-advancing heads up on emerging disease outbreaks, and we can respond more quickly and focus our targeted resources on prevention activities. Text messaging on cell phones has also had a huge impact on the coordination of our health activities. A nurse providing care to an HIV/AIDS patient in the slums of Nairobi, for instance, no longer has to work alone; he can communicate more easily with other health care providers throughout the country. Communication in these countries can be so difficult and so limited, but we’re better able to share information now.

ZocDoc: What are your ultimate goals for a country, and how do you measure that success?

Aossey: Our goal is to give people the skills they need to care for people in their own community. When you look at inequities in health care, they often are the result of people not having access to health care, or access to health workers. Our health care worker is the most critical piece of our work, so we invest heavily in that training, the testing, and the refresher training. In regards to measuring our effectiveness, we measure it very differently depending on what is happening in that particular country. But our broad goal is to save lives by providing emergency health care, and then to lay the foundation for restoring health care systems by this training capacity. What we do is an important component of this self reliance. There are a lot of small victories along the way. For instance in Afghanistan, there are still a lot of political problems and violence, there’s no question about it, but most of the work we’re doing is carried out directly by Afghan nationals. We support them, financially and through training in various forms, but the work is being done by the people in that country. These are the important victories along the way by which we measure success.

ZocDoc: Hurricane Katrina was the first time International Medical Corps did any kind of emergency response work in the United States. What was that experience like?

Aossey: This was a new one. We just knew when we saw the devastation that we needed to respond. We are used to operating in areas where there’s a lot of chaos and confusion, where the needs are great, and it’s not easy to operate. None of that frightened us – we’re often in war zones. But we didn’t understand that the modus operandi of disaster response in the US, at least in this situation, was so archaic. The needs in Louisiana after Katrina were really not that much different from something we encounter after a tropical storm in Africa or Asia. What shocked us as Americans was that, given how strong America is in so many regards, the basic communication and coordination mechanisms were not in place. The lack of information was shocking, and we had to very quickly adapt our approach to that unanticipated reality. No one knew where to go or what to do, and there were certain areas that were completely uncovered. The communication channels weren’t there, so it was almost impossible to do any kind of coordination. That was a real eye opener for us.

ZocDoc: What were you able to do in the impacted region?

Aossey: In the immediate aftermath of the hurricane we prioritized relief activities in three areas: primary health care support, psychosocial support, and direct assistance through targeted grants for community-based organizations responding to the disaster. In 2006, after the initial emergency had passed, we sent teams to the area and conducted a study to inform the recovery efforts for the internally displaced people living in the FEMA trailer parks in Louisiana and Mississippi. We used our global humanitarian perspective to assess the health status and the basic needs and opinions, and we did this especially in regards to women’s health and mental health needs. What we found was that while the initial humanitarian relief finally did address the basic needs – food, water, and temporary housing – of the displaced population, there were serious gaps that persisted. Permanent housing solutions and health services, mental health, security, transportation remained largely unaddressed. I think what we always assumed was that America was well prepared in disaster response, and we didn’t realize how far the US had been left behind in current thinking, at least in this particular case. And not just in disaster response, but risk reduction. Hopefully there will be a lot of lessons learned.

ZocDoc: Would International Medical Corps consider working in the US again?

Aossey: First and foremost, we want to help wherever needs are being unmet, including our own country. Our focus has always been international because that’s where many of the unmet needs have been, but certainly we care deeply about America and would work in the US again.

ZocDoc: As an American based organization, how are you generally received abroad?

Aossey: Over our 25 year history, our experience is that we have been widely and well received almost everywhere we’ve operated. When a volunteer American doctor leaves the comfort of her home in the US to travel to a place a long way away for little or no pay to work in a conflict area and risk her life to help people that she might not see again – her great sacrifice is not lost on local populations. The image of the American doctor, the American nurse, and the American health care professional is still highly respected and held in great regard throughout much of the world – it’s America at its best.